Department of Social Work, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
School of Social Welfare, University of California, Berkeley, 120 Haviland Hall (MC #7400), Berkeley, CA, 94720-7400, USA.
Adm Policy Ment Health. 2021 Nov;48(6):942-961. doi: 10.1007/s10488-021-01112-y. Epub 2021 Feb 3.
Outpatient civil commitment (OCC) requires people with severe mental illness (SMI) to receive needed-treatment addressing imminent-threats to health and safety. When available, such treatment is required to be provided in the community as a less restrictive alternative (LRA) to psychiatric-hospitalization. Variance in hospital-utilization outcomes following OCC-assignment has been interpreted as OCC-failure. This review seeks to specify factors accounting for this outcome-variation and to determine whether OCC is used effectively. Twenty-five studies, sited in seven meta-analyses and subsequently published investigations, assessing post-OCC-assignment hospital utilization outcomes were reviewed. Studies were grouped by structural pre-determinants of hospital-utilization and OCC-implementation-i.e. deinstitutionalization (bed-availability), availability of a less restrictive alternative to hospitalization, and illness severity. Design quality at study completion was ranked on causal-certainty. In OCC-follow-up-studies, deinstitutionalization associated hospital-bed-cuts, when not taken into account, ensured lower hospital-bed-day utilization. OCC-assignment coupled with aggressive case-management was associated with reduced-hospitalization. With limited community-service, hospitalizations increased as the default option for providing needed-treatment. Follow-up studies showed less hospitalization while on OCC-assignment and more outside of it. Studies using fixed-follow-up periods usually found increased-utilization as patients spent less time under OCC-supervision than outside it. Comparison-group-studies reporting no between-group differences bring more severely ill OCC-patients to equivalent use as less disturbed patients, a success. Mean evidence-rank for causal-certainty 2.96, range 2-4, of 5 with no study ranked 1, the highest rank. Diverse mental health systems yield diverse OCC hospital-utilization outcomes, each fulfilling the law's legal mandate to provide needed-treatment protecting health and safety.
门诊民事承诺 (OCC) 要求患有严重精神疾病 (SMI) 的人接受必要的治疗，以解决对健康和安全的迫在眉睫的威胁。在可行的情况下，这种治疗需要在社区中进行，作为精神病院住院的限制较少的替代方案 (LRA)。OCC 分配后医院利用结果的差异被解释为 OCC 失败。本综述旨在具体说明导致这种结果变化的因素，并确定 OCC 是否被有效使用。评估 OCC 分配后医院利用结果的 25 项研究，分别位于 7 项荟萃分析和随后发表的调查中，进行了审查。研究按结构预先确定的住院利用因素和 OCC 实施分类，即去机构化（床位可用性）、提供非住院限制较少的替代方案和疾病严重程度。研究完成时的设计质量按因果确定性进行排名。在 OCC 随访研究中，如不考虑去机构化相关的床位削减，将确保住院床位日利用率降低。OCC 分配加上积极的病例管理与减少住院相关。由于社区服务有限，住院成为提供必要治疗的默认选择，住院人数增加。随访研究表明，在 OCC 分配期间和之后，住院时间减少。使用固定随访期的研究通常发现，随着患者在 OCC 监督下的时间减少，利用增加。报告组间无差异的对照研究将病情较重的 OCC 患者与病情较轻的患者同等使用，这是一种成功。因果确定性的平均证据等级为 2.96，范围为 2-4，其中没有研究等级为 1，即最高等级。不同的心理健康系统产生不同的 OCC 医院利用结果，每个系统都满足法律提供必要治疗以保护健康和安全的法律要求。
